El-Barhoun Esber N, Chew Ghee, Crouch Benjamin, Chatterton Barry
Department of Nuclear Medicine, Royal Adelaide Hospital, North Tce, Adelaide, South Australia, Australia.
Hell J Nucl Med. 2017 Jan-Apr;20(1):71-75. doi: 10.1967/s002449910509. Epub 2017 Mar 20.
Evaluation of regional lung function is valuable prior to lung surgery in patients with chronic lung disease. Our aim was to evaluate the reproducibility of a locally developed single photon emission tomography/computed tomography (SPET/CT) programme between and within three observers in assessing lobar pulmonary volumes, perfusion and ventilation.
Twelve lung transplantation candidates had VQ SPET and diagnostic CT to determine lobar pulmonary function and plan surgery. Their data were used retrospectively in an in-house developed programme which delineates the lung fissures on the diagnostic CT as an anatomical template used to estimate the volume of each of 5 lung lobes. These anatomical volumes were then applied to the corresponding ventilation ( Tc technegas) and perfusion ( Tc MAA) SPET studies. The data were anonymised, duplicated and then processed in random order blindly by 3 readers several weeks apart. Nine studies could be adequately processed. The programme failed in delineating lung volumes in 2 subjects and there was data corruption in the third. The results were evaluated for inter- and intra- observer variability using an intra-class Correlation Coefficient (ICC). An ICC score was calculated for each lobe for volume, ventilation and perfusion.
Inter- and intra- observer ICC scores for ventilation, and perfusion scans were all very high. Similar very strong ICC concordance scores were noted for volume except intra-observer ICC scores for left upper lobe (0.76) and right mid lobe (0.66) where scores showed strong concordance by standard statistical descriptors. The method was sensitive enough to demonstrate the expected gradient of ventilation/perfusion even in these patients with substantial pathology.
Our method of lobar VQ SPET with CT quantitation has high inter- and intra- observer concordance and in this preliminary data set seems to be a reliable and reproducible test for semi-quantitation of differential volume, ventilation and perfusion of the lobes of the lungs.
对于慢性肺病患者，在肺手术前评估局部肺功能很有价值。我们的目的是评估本地开发的单光子发射断层扫描/计算机断层扫描（SPET/CT）程序在三名观察者之间以及观察者内部评估肺叶肺容积、灌注和通气的可重复性。
12名肺移植候选者接受了通气/灌注单光子发射断层扫描（VQ SPET）和诊断性计算机断层扫描（CT），以确定肺叶肺功能并制定手术方案。他们的数据在一个内部开发的程序中进行回顾性分析，该程序在诊断性CT上描绘肺裂，作为用于估计5个肺叶各自容积的解剖模板。然后将这些解剖学容积应用于相应的通气（锝气体）和灌注（锝大聚合白蛋白）单光子发射断层扫描研究。数据进行匿名处理、复制，然后由3名读者在相隔数周的时间里以随机顺序盲目处理。9项研究能够得到充分处理。该程序在2名受试者中未能描绘出肺容积，第三名受试者存在数据损坏。使用组内相关系数（ICC）评估观察者间和观察者内的变异性。计算每个肺叶在容积、通气和灌注方面的ICC分数。
通气和灌注扫描的观察者间和观察者内ICC分数都非常高。除左上叶（0.76）和右中叶（0.66）的观察者内ICC分数外，容积方面也观察到类似的非常强的ICC一致性分数，根据标准统计描述符，这些分数显示出很强的一致性。即使在这些有严重病变的患者中，该方法也足够灵敏，能够显示出预期的通气/灌注梯度。
我们的肺叶VQ SPET结合CT定量分析方法在观察者间和观察者内具有高度一致性，在这个初步数据集中似乎是一种可靠且可重复的测试，用于对肺叶的差异容积、通气和灌注进行半定量分析。
